Reducing stress responses in the pre-bypass phase of open heart surgery in infants and young children: a comparison of different fentanyl doses
| Autor: | A. H. Cloote, A. K. Pawade, Andrew R. Wolf, P.J. Murphy, Patricia Weir, I. Jenkins, Heather P Duncan, C.A. Rogers |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Blood Glucose
Heart Defects Congenital Male Narcotics medicine.medical_specialty Hydrocortisone Heart disease Hemodynamics Anesthesia General law.invention Fentanyl Cardiovascular Physiological Phenomena Catecholamines law Preoperative Care Cardiopulmonary bypass Humans Medicine Prospective Studies Dose-Response Relationship Drug business.industry Infant Newborn Infant Dose-ranging study medicine.disease Cardiac surgery Surgery Anesthesiology and Pain Medicine Isoflurane Opioid Child Preschool Anesthesia Female business medicine.drug |
| Zdroj: | British Journal of Anaesthesia. 84:556-564 |
| ISSN: | 0007-0912 |
| DOI: | 10.1093/bja/84.5.556 |
| Popis: | High-dose opioids are advocated for paediatric cardiac surgery to suppress stress responses but they can produce unwanted side effects. There are no data on the dose-dependent effects of opioids on the stress response on which to base rational opioid administration. We conducted a dose ranging study on 40 children less than 4 yr undergoing elective open heart surgery using one of five fentanyl doses: 2, 25, 50, 100 or 150 micrograms kg-1 before surgery. The standardized anaesthetic also included pancuronium and isoflurane. Blood samples were taken at induction, before incision, after sternotomy, immediately before, and at the end of cardiopulmonary bypass. Patients in the 2 micrograms kg-1 group had significant rises in prebypass glucose (P0.01), pre- and post-bypass cortisol (P0.01), and pre- and post-bypass norepinephrine (P0.01). No significant rise occurred in glucose, cortisol and catecholamines in any of the higher dosage groups. Patients in the 2 micrograms kg-1 group had significantly higher mean systolic blood pressure (P0.02) and heart rate (P0.04). A balanced anaesthetic containing fentanyl 25-50 micrograms kg-1 is sufficient to obtund haemodynamic and stress responses to the pre-bypass phase of surgery. Higher doses of fentanyl (100 and 150 micrograms kg-1) offer little advantage over 50 micrograms kg-1, and can necessitate intervention to prevent hypotension. |
| Databáze: | OpenAIRE |
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